Dr Jie Li1, Dr Wenjing Xi1, Dr Sally Ng2, Dr Zheng Zhang1, Dr Ke Li1, Dr Xiaodian Wang1, Dr Weijie Su1, Dr Jingyan Wang3, Prof Yixin Zhang1
1Department of Plastic and Reconstructive Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 2Alfred Health/ The Victorian Adult Burns Service, , Australia, 3Department of Plastic and Reconstructive Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Background: Fractional CO2 laser has been considered to be a complement treatments, which could loosen graft contraction and restore the surface smoothness. However, optimal treatment protocol remains unknown. This study applied a dual-scan protocol to achieve three-dimensional releasing and ablation of contracted skin graft. We comprehensively described this treatment method and compared the effectiveness and safety between this dual-scan method and the conventional mono-scan mode.
Methods: A hypercontracted scar model after skin grafting in red Duroc pigs was established. All scars meeting the inclusion criteria were randomly divided into four groups: high fluence–low density (HF–LD), low fluence–high density (LF–HD), combined group, and control group. The energy per unit area was similar in the HF–LD and LF–HD groups. Two laser interventions were performed at a 6-week interval. The effectiveness of the treatment results was evaluated by objective means of scar area, release rate, elasticity, thickness, and flatness, while the safety was evaluated based on adverse reactions and melanin index. Collagen structure was observed histologically. The animals were followed up for a maximum of 126 days after modeling.
Results: A total of 28 contracted scars were included, 7 in each group. At 18 weeks postoperatively, the HF–LD and the combined groups showed significantly increased scar release rate (p 0.000), elasticity (p 0.036) and decreased type I/III collagen ratio (p 0.002) compared with the control and LF–HD groups. In terms of flatness, the combined group was significantly better than the HF–LD group for elevations thinner than 1mm (p 0.019). No significant skin side effects, pigmentation or scar thickness changes were observed at 18 weeks.
Conclusion: The results showed that the dual-scan protocol could achieve superficial ablation and deep release of contracted skin graft in a single treatment, increasing scar release, elasticity, and surface flatness.
Dr Sally Ng is a Melbourne trained specialist plastic reconstructive surgeon with an interest in burns scar management and reconstruction. She holds a visiting medical officer appointment with the Victorian Adult Burns Services. She has completed sub-speciality training in scar reconstruction including laser at the Ninth People Hospital in Shanghai.